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British Dental Journal (BDJ)Simultaneous Presentation of Dual Pathologies Within the Oral Cavity: An Unusual and Diagnostically Challenging Presentation

Navigating the Diagnostic Maze of Necrotising Sialometaplasia and Pericoronitis

A recent case report from Birmingham Dental Hospital highlights the diagnostic challenges of necrotising sialometaplasia (NS), a rare oral condition, especially when it presents alongside another pathology like pericoronitis. The case involved a 22-year-old South Asian woman who initially sought treatment for pain in her lower third molars and palate. After extensive tests, she was diagnosed with non-ulcerative NS and pericoronitis, a unique presentation not previously documented in scientific literature.

HCN Medical Memo
This case serves as a reminder of the complexities involved in diagnosing rare oral conditions like NS, particularly when they present alongside more common issues like pericoronitis. It emphasizes the necessity of comprehensive diagnostic tests to rule out malignancies and the importance of listening to patient complaints carefully. In a field where time is often limited, a thorough examination and a high index of suspicion can make all the difference in patient outcomes.

Key Points:
  • Complex Presentation: The patient had symptoms in her lower third molars and palate, initially misdiagnosed as a viral upper respiratory infection.
  • Diagnostic Tests: A range of tests including dental panoramic tomograms, blood samples, and ultrasound scans were conducted to reach a definitive diagnosis.
  • Dual Pathologies: The patient was diagnosed with both non-ulcerative NS and pericoronitis, a combination not previously reported.
  • Dentist Perspectives: The case underscores the importance of thorough examination and diagnostic tests to rule out malignancies and avoid unnecessary invasive treatments.

Necrotising sialometaplasia accounts for just 0.03% of all lesions biopsied from the oral cavity.

Additional Points:
  • Differential Diagnoses: The case considered multiple differential diagnoses, including pleomorphic adenomas, non-Hodgkin lymphoma, and squamous cell carcinomas.
  • Histopathological Analysis: The biopsy showed features like acinar atrophy and squamous metaplasia, which were key in confirming NS.
  • Management: The patient was educated about her condition and reassured that it was self-limiting. Symptomatic relief was provided, and she was monitored via telephone due to the SARS-COV-2 pandemic.

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